Pay As You Go
Home Contents Insurance
Peace of mind at an affordable cost
Application
It is important that the sum insured chosen (in round sums of £1000) is sufficient to
cover the full replacement cost of all your household goods and personal effects.
Underwritten by Allianz Insurance plc. Registered in England number 84638. Registered office:
57 Ladymead, Guildford, Surrey GU1 1DB, United Kingdom. Allianz Insurance plc is authorised
by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and
the Prudential Regulation Authority. Allianz Insurance plc is on the Financial Services Register,
registration number 121849
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Personal Details
FOR OFFICE USE ONLY
Rent Ref No: Premium:
Start Date:
PLEASE USE CAPITAL LETTERS WHEN FILLING IN THIS FORM
Are you a tenant of East Lothian Council:
Your Full Name (Mrs/Ms/Miss/Mr/other)
(Joint tenants + Co-habitees must be named)
Address
Mobile no. Post Code
Email address Date of Birth
Telephone no.
Contents Sum Insured required £ __________________
Do you require extended accidental damage cover at an additional cost Yes No
If you require any of the additional covers below (at extra cost) please tick the appropriate
box and specify the amount of cover you require
a)
Personal Possessions (cover away from the home including pedal cycles)
£
(available in bands of £1,000 up to max £5,000)
b) Gardens Huts, Garages & Greenhouses
£500
c) Hearing Aids (available in bands of £1,000 up to max £3,000)
£
d) Wheelchairs (available in bands of £1,000 up to max £5,000)
£
Where did you hear about this insurance scheme?
PLEASE ANSWER ALL THE QUESTIONS BELOW.
WE CAN ONLY CONSIDER YOUR APPLICATION ONCE ALL
THESE QUESTIONS HAVE BEEN ANSWERED.
(Please tick the correct box in answer to the questions below)
1. Is your home self-contained with its own separate lockable front door?
2. Is this property your permanent home and occupied only by yourself and
members of your immediate family normally living with you?
3. Does the amount of insurance you have chosen cover the full cost of replacing
all your household goods and personal belongings?
If you have answered NO to any of the above questions, please give more details below
(use a separate sheet if more space is needed).
4. Do you ever leave your home empty or unattended for more
than 60 days in a row?
5. Is your home used for running a business?
6. Have you or anyone living with you ever been refused insurance or
had special terms imposed by an insurer?
If you have answered YES to any of the above questions, please give more details below
(use a separate sheet if more space is needed).
7. Have any incidents occurred in the last three years which would have caused
you to make a claim for household contents or personal effects, whether or
not you were insured at the time?
If you have answered YES to the above question, please give us the following information
(use a separate sheet if more space is needed)
Date(s) of incident(s)
What caused the loss (theft, water damage etc.)?
Value of goods lost or damaged?
Were you insured at the time?
If so, how much did the insurers pay in settlement of the claim?
Since the loss have all items which were damaged/lost been replaced?
8. Do you or anyone living with you have any unspent criminal convictions
other than motoring convictions, or have any prosecutions pending?
If you have answered YES to the above question, please tell us:
Date of conviction or charge?
Nature of offence?
Penalty received (fine, custody etc.)?
Your age at the time?
Yes No
Yes No
Yes No
Yes No
To be answered by the applicant
Declaration
PLEASE READ THE DECLARATION BELOW CAREFULLY BEFORE SIGNING IT
(to be completed after entering the information requested opposite and overleaf)
1. I/We agree to advise the Council if any of the answers given above should change.
2. I/We declare that all questions have been fully completed and the answers are true and
correct to the best of my/our knowledge and belief. Failure to answer truthfully and
completely may mean that your policy becomes invalid or does not operate in the event
of a claim. If you are in any doubt please contact Insurance & Risk, Policy & Performance,
Protective Services, East Lothian Council, John Muir House, Haddington EH41 3HA. Tel:
01620 827255 or 827876 .
3. I/We declare that we understand the contents of this completed application including
the important information for applicants at the start of this form.
4. I/We declare that Allianz Insurance plc may contact my/our present insurer for further
information.
5. I/We undertake to pay the premium when called upon to do so.
6. I/We understand that any incident we give details of in this application may be checked
against the Claims and Underwriting Exchange database. The aim is to help check the
information provided and also to prevent fraudulent claims. When you tell us of an
incident that occurs in the future, we will pass information relating to this to the
database.
Special Note
If during the period of your insurance cover, your home is likely to be unoccupied (e.g.
through hospitalisation, extended holiday) for more than 60 days in a row you must contact
the Council to establish whether cover can continue.
Signature(s) Signature(s)
Date
This document is available in large print and Braille if required.
If you are completing the form on-line you can submit your application by clicking the
SUBMIT BUTTON below.
Joint tenants should both sign unless
they are married to each other
Joint tenants should both sign unless
they are married to each other
PLEASE TYPE NAME(S) AND DATE IF
COMPLETING THE FORM ELECTRONICALLY.
SUBMIT
For more information about how Allianz Insurance plc use your personal data, you can find a copy of the Fair Processing
Notice at www.allianz.co.uk. Alternatively, you can request a printed version by calling 0330 102 1837, by email
dataprotectionofficer@allianz.co.uk or by writing to the Data Protection Officer, Allianz, 57 Ladymead, Guildford, Surrey
GU1 1DB.
Claims History
G Under the conditions of your policy you must tell us about any incidents (such as fire, water damage, theft or an
accident) whether or not they give rise to a claim. When you tell us about an incident we will pass information
relating to it to a database.
G We may search these databases when you apply for insurance, in the event of any incident or claim, or at a time of
renewal to validate your claims history or that of any other person or property likely to be involved in the policy or
claim.
Important Notice
155646 East Lothian AUTOAD+EXT 6/2018
Pay As You Go
Home Contents Insurance
1
East Lothian Council does not insure your furniture, belongings or
decorations against theft, fire, vandalism and burst pipes and other household
risks. You need to take out your own insurance. Under a special scheme
arranged with Allianz Insurance plc, it’s easy for you to protect your
belongings.
You can arrange your insurance at a special low cost rate.
The scheme is open to all tenants.
Payment of the premium
Premiums can be paid fortnightly alongside your rent.
Insurance for your furniture, TV, clothing, carpets, electrical
items and general household goods
When you take out this insurance most of your household goods and contents will be insured
in your home. The insurance also covers replacement of external locks if your keys are lost or
stolen and the contents of your freezer. There is also cover for personal liability, and cover for
damage to your landlords fixtures and fittings which you may be legally responsible for under
the terms of your tenancy agreement. Full details of the policy cover applying are available on
request.
Insurance against fire, theft, vandalism, water damage and
other household risks
These are examples of the types of risk your contents will be insured for.
Full details of the policy cover applying are available on request.
Optional Extras
In addition to your standard contents cover, you have the option to add any of the following
additional covers at an extra cost:
- Extended accidental damage cover
- Personal possessions cover (cover for possessions away from the home)
- Cover for the structure of garden huts, greenhouses and garages
- Hearing aid cover
- Wheelchair cover
‘New-for-Old’ insurance
All your home contents are covered by the policy on a ‘new for old’ basis, with the exception
of linen and clothing which will be replaced at their current cost, less an amount for wear and
tear. When you are working out the cost of your insurance, you will need to work out how
much it will cost to replace the full contents.
If you underinsure your contents, any claim
payment will be reduced to the same proportion as the contents sum insured bears to
the full replacement cost.
Special low minimum sums insured
The lowest amount that can be insured is:
£7,000 for tenants aged 60 and over
£10,000 for all other tenants
Cost of Insurance
You can work out the cost of your insurance by following these three easy steps:
1. Use the do-it-yourself valuation sheet opposite to work out how much cover you need.
2. Now refer to the premium tables on page 5 to select the premium you will pay.
Pay As You Go
Home Contents Insurance
2
7
6
5
4
3
Standard Cover £
Extended Accidental Damage Cover £
Personal Possession £
Wheelchairs & Mobility Scooters £
Hearing Aids £
Sheds & Garages £
Total Premium £
You can use the below to work out your Premium
If you have selected any of the
optional covers insert the
premium in boxes 2 to 6.
Add boxes 1 to 6 together and
place the total in box 7.
If you need help working out your
premium you can contact us on
01620 827255 or 827876.
1
2
Rooms/Items:
Items in living room 1. e.g. TV, Radio, Video, Hi-Fi, Satellite
Equipment, Computer, Suite, Carpet, Tables, Other Furniture,
CD’s, Videos, Light Fittings, Books, Ornaments, Curtains etc.
Items in living room 2. e.g. Dining Table, Chairs, Sideboard,
Other Furniture, Carpets, Curtains, Light Fittings, Ornaments etc.
Items in kitchen. e.g. Cooker, Washer, Fridge, Freezer,
Pots & Pans, Crockery, Table, Chairs, Floor Covering, Light
Fittings, Ornaments, Microwave, Toaster, Kettle, Other Electrical
Items etc.
Items in bedroom 1. e.g. Bed, Bedroom Furniture, Carpet,
Curtains, Light Fittings, Clock, Bedding, Jewellery, Ornaments,
Games, Toys, Towels, Computer, Clothing etc.
Items in bedroom 2. e.g. Bed, Bedroom Furniture, Carpet,
Curtains, Light Fittings, Clock, Bedding, Jewellery, Ornaments,
Games, Toys, Towels, Computer, Clothing etc.
Items in bedroom 3. e.g. Bed, Bedroom Furniture, Carpet,
Curtains, Light Fittings, Clock, Bedding, Jewellery, Ornaments,
Games, Toys, Towels, Computer, Clothing etc.
Other items. e.g. Vacuum Cleaner, Tools, Lawnmower,
Gardening Equipment etc.
Total Value
£
Do-it-yourself valuation of your household contents
Most people find that their household contents are worth more than they think.
Please use this page to help value the contents of your property but first read the section on
‘New for Old’ insurance on page 2.
Add up the Total Value column and round the total figure up to nearest £1,000,
then enter this figure on the application form.
Please keep this sheet for future reference
Pay As You Go
Home Contents Insurance
3
How to apply
Complete the application form and post to: Insurance & Risk, Policy & Performance, Protective
Services, East Lothian Council, John Muir House, Haddington EH41 3HA.
Alternatively if you are completing the form electronically please use the click and submit
button on the declaration page.
If you want any help filling in the form, please contact us on Tel: 01620 827255 or 827876.
Keeping up the payments
To make sure that you are always covered you must keep up to date with your payments.
You will not be allowed to make a claim unless your payments are up to date.
Your insurance maybe cancelled if you don’t keep your premiums up to date.
Start date
Cover will start as soon as your application has been accepted.
A policy and certificate of insurance detailing the sum insured, premium and cover will be
sent to you.
Special Notes
If during the period of your insurance cover your home is likely to be unoccupied (e.g.
through hospitalisation, extended holiday) for more than 60 days in a row, or if there is any
change in your risk circumstances such as a change of address, you will have to advise in
writing.
Remember, it is your responsibility to establish whether cover can continue and that the
sum insured is sufficient to cover all your household items and personal effects.
You need to have a clear rent account to be accepted on the scheme.
East Lothian Council urges all tenants to take out home contents insurance, either
through our special scheme or by making your own arrangements.
If you wish to apply complete the application form attached.
Pay As You Go
Home Contents Insurance
4
Pay As You Go
Home Contents Insurance
5
These costs include Insurance Premium Tax at the current rate.
* £7,000 - £35,000 for tenants aged 60 and cover.
£10,000 - £35,000 available to all other tenants.
Over 60s only
Sum
I
nsured
*£7,000 £0.84 £1.18
*£8,000 £0.96 £1.34
*£9,000 £1.08 £1.52
£10,000 £1.20 £1.68
£11,000 £1.32 £1.84
£12,000 £1.44 £2.02
£13,000 £1.56 £2.18
£14,000 £1.68 £2.36
£15,000 £1.80 £2.52
£16,000 £1.92 £2.68
£17,000 £2.04 £2.86
£18,000 £2.16 £3.02
£19,000 £2.28 £3.20
£20,000 £2.40 £3.36
£21,000 £2.52 £3.52
Standard Cover
Fortnightly
P
remium
Standard Cover
inc Extended
Acc Damage
F
ortnightly
Premium
Over 60s only
Sum
I
nsured
£22,000 £2.64 £3.70
£23,000 £2.76 £3.86
£24,000 £2.88 £4.04
£25,000 £3.02 £4.20
£26,000 £3.14 £4.36
£27,000 £3.26 £4.54
£28,000 £3.38 £4.70
£29,000 £3.50 £4.88
£30,000 £3.62 £5.04
£31,000 £3.74 £5.20
£32,000 £3.86 £5.38
£33,000 £3.98 £5.54
£34,000 £4.10 £5.72
£35,000 £4.22 £5.88
Option Type Sum Insured Fortnightly Premium
Personal Possessions (cover away £1,000 £0.84
from the home) £2,000 £1.68
£3,000 £2.52
Wheelchairs, Mobility Scooters £1,000 £0.92
£2,000 £1.84
£3,000 £2.78
Hearing Aids £1,000 £0.92
£2,000 £1.84
£3,000 £2.78
Huts, Garages and Greenhouses
(structure cover) £500 £0.54
Standard Cover
Fortnightly
P
remium
Standard Cover
inc Extended
Acc Damage
F
ortnightly
Premium
This is a Policy Summary only and does
not contain the full terms and conditions of
the contract. It does not form part of the
contract between you and us. Full terms
can be found in the Policy Wording, a copy
of which is available on request.
What is Home Contents Insurance and
what does it cover me for?
Home Contents Insurance is a tenants
insurance policy that provides standard
contents cover for your belongings (not
used for business purposes) within
your home.
What happens if I take out cover and
then change my mind?
The policy provides you with a 14 day
reflection period to decide whether you
wish to continue. This is subject to certain
terms, full details are shown in the full
policy wording which is available
on request.
How do I notify a claim under Home
Contents Insurance
To report a loss contact Allianz Insurance
plc, their details can be found in the policy
wording which will be sent to you.
How do I make a complaint about my
Home Contents policy?
If you have a complaint about anything
other than the sale of the policy please
contact our
Customer Satisfaction Manager at:
Allianz Insurance Plc
2530 The Quadrant
Aztec West
Almondsbury
Bristol
BS32 4AW
Phone: 0800 072 4760
Fax: 01483 529717
Email: allianzretailcomplaints@allianz.co.uk
If we are unable to resolve the problem we
will provide you with information about the
Financial Ombudsman Service.
Full details of our complaints procedure
may be found in your policy
documentation.
Using our complaints procedure or referral
to the Financial Ombudsman Services does
not affect your legal rights.
Would I receive compensation if Allianz
Insurance plc were unable to meet its
liabilities?
In the event that Allianz Insurance plc is
unable to meet its liabilities you may be
entitled to compensation from the Financial
Services Compensation Scheme (FSCS).
Further details are in your policy wording.
Contents
The policy covers your household goods
and personal belongings whilst they are
within your home, against unexpected loss
or damage, for example by fire or theft.
Policy Summary
Allianz Insurance plc. Registered in England number 84638. Registered office: 57 Ladymead, Guildford, Surrey GU1 1DB, United Kingdom.
Allianz Insurance plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the
Prudential Regulation Authority. Allianz Insurance plc is on the Financial Services Register, registration number 121849.
Full details can be found in the Policy Cover
section of your policy the key exclusions
and limitations are set out below.
We will not cover you for theft if your
home is lent, let or sublet, unless force is
used to get into or out of your home.
A limit of £300 applies in respect of
Personal Money
A limit of £500 applies in respect of
cover for each credit card
A limit of £2000 applies in respect of
theft of your belongings from your
outbuildings
A limit of £1500 applies in respect of
tapes, discs or record discs of any kind
to do with home entertainment
equipment
Tenants improvements that you make as
a tenant are covered up to 20% or
£2,000 whichever is the greater.
Under the extended accidental
damage extension (Section T) you are
not covered for:-
Accidental damage caused by pets
Accidental damage to clothing
Cover under sections U, V, W & X will
only apply if you have paid the additional
premium to include this section.
Under the Personal Possessions option
(Section U) you are not covered for:-
Any one claim is limited to £1000 per
item
Loss or damage caused in any way
connected to professional entertaining
Loss or damage to sports equipment
whilst in use
Loss or damage while your home is
unoccupied
Under the Garden huts, garages and
greenhouses option (Section V) you are
not covered for:-
Loss or damage caused by domestic pets
Loss or damage while your home is
unoccupied
Under the Wheelchair & Hearing aid
options (Section W&X) you are not
covered for:-
Any amount over £1,000 for theft or
attempted theft from any unattended
vehicle
Loss or damage to accessories and
batteries
Loss or damage caused by
corrosion, repair or refurbishment
domestic pets
confiscation or detention by customs or
other official bodies
On what basis are claims settled?
We will pay to replace property or
belongings lost or destroyed and we will pay
to repair damaged items.
We will make a deduction for wear and tear
for claims on clothes or household linen. We
will pay for the damaged items that are part
of a set or suite but we will not pay for the
other pieces which are not damaged. This is
not a maintenance contract. This means that
wear and tear or anything that happens
gradually and electrical or mechanical
breakdown is not covered.
Unoccupancy
The policy excludes certain loss or damage
if no-one is living at the property for more
than 60 days in a row. If this applies to
you, you will not be covered for theft,
malicious people or water leaking from pipes
and heating installations.
Pay As You Go
Home Contents Insurance
8
IMPORTANT INFORMATION FOR APPLICANTS
This form details the information on which the contract of insurance is based.
You must ensure that all questions have been fully completed
and the answers are true and
correct to the best of your knowledge and belief.
If there are any inaccuracies or omissions let your Landlord know immediately.
FAILURE TO DO THIS MAY MEAN THAT YOUR POLICY BECOMES INVALID OR DOES
NOT OPERATE IN THE EVENT OF CLAIM
You should keep a copy of all information and correspondence you supply to us in connection
with your application. A copy of this form will be supplied on request for a period of three
months after its completion.
A copy of the Policy Wording is available on request.
You are not covered until your application has been accepted by Allianz Insurance plc or
your Administrator.
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